本文選題：眩暈 + 眼震�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的良性陣發(fā)性位置性眩暈(benign positional paroxysmal vertigo,BPPV)即耳石癥,是當(dāng)前臨床極為常見的眩暈類疾病,常累及后半規(guī)管及水平半規(guī)管。它是一種反復(fù)發(fā)作的、由頭位相對重力方向變換所引發(fā)短暫性眩暈和眼球震顫的前庭外周疾病,其癥狀具有自行緩解的特點(diǎn)。目前,BPPV的診斷通常是依靠位置試驗(yàn)檢查所引出的典型眼震來確定。本文應(yīng)用視頻眼震圖(video nystagmo graph,VNG)技術(shù),分析不同類型BPPV在Roll test和Dix-Hallpike test兩種診斷性檢查中引出眼震的參數(shù)特征,探討B(tài)PPV誘發(fā)眼震機(jī)制及位置試驗(yàn)在其臨床診療中的優(yōu)選方案,為該癥責(zé)任半規(guī)管的診斷提供客觀參照依據(jù)。方法2015年10月至2017年1月就診于天津市第一中心醫(yī)院耳鼻咽喉頭頸外科門診的位置性眩暈患者共740例。包含BPPV患者735例,男237例,女498例,男女之比1:2.1。其中后半規(guī)管管石癥(Posterior Semicircular Canal Canalithasis,PSC-Can)510例,水平半規(guī)管管石癥(Horizontal Semicircular Canalithasis,HSC-Can)183例,水平半規(guī)管壺腹嵴頂結(jié)石癥(horizontal semicircular canal cupulolithiasis,HSC-Cup)42例;另有輕嵴帽(Light Cupula,LC)患者5例。詳細(xì)采集以上患者的眩暈病史(包括眩暈特點(diǎn)、發(fā)作時間、發(fā)作頻率、伴隨癥狀、既往史及發(fā)作誘因等),并完善耳科學(xué)檢查及前庭功能檢查、影像學(xué)檢查,排除中樞性病變者、存在各類型自發(fā)眼震者及其他種類BPPV(包含PSC-Cup、前臂HSC-Can、前半規(guī)管BPPV)。使用VNG詳細(xì)描記全體受檢者Roll test和Dix-Hallpike test所刺激產(chǎn)生的眼震,對比各檢查各頭位引出眼震的參數(shù)特性。在SPSS 19.0統(tǒng)計(jì)軟件的支持下進(jìn)行數(shù)據(jù)處理。結(jié)果PSC-Can患者在Dix-Hallpike test懸頭位都能夠引出垂直向上為主的眼震,起身端坐后眼震方向相反,強(qiáng)度較懸頭位減弱,懸頭位和端坐位引出垂直眼震強(qiáng)度(均數(shù)±標(biāo)準(zhǔn)差)分別是(29.5±12.7)°/s和(13.1±7.2)°/s,差異有統(tǒng)計(jì)學(xué)意義(t=18.615,P0.05);懸頭位和端坐位引出典型眼震的持續(xù)時間分別是(13.7±7.1)s和(13.5±6.9)s,無統(tǒng)計(jì)學(xué)差別(t=0.089,P0.05)。但PSC-Can患者在Roll test中未能引出典型連續(xù)性眼震。HSC-Can患者行Roll test檢查呈現(xiàn)出水平相為主且與扭頭同向的眼震,在患側(cè)及健側(cè)引出眼震的強(qiáng)度分別是(41.5±15.8)°/s及(20.2±7.7)°/s,眼震強(qiáng)度均值之比約為2.1:1,眼震持續(xù)時間分別是(22.1±6.1)s和(21.3±5.9)s,差異均有統(tǒng)計(jì)學(xué)意義(t值分別是10.637和3.724,P均0.05);并且169例HSC-Can患者行Dix-Hallpike test后表現(xiàn)出水平相為主的眼震。HSC-Cup患者在行Roll test檢查后呈現(xiàn)出水平相為主與扭頭反向的眼震,向健側(cè)扭頭所引出的眼震較患者強(qiáng),向患側(cè)及健側(cè)扭頭引出的眼震強(qiáng)度分別是(18.0±8.1)°/s及(40.27±16.6)°/s,強(qiáng)度之比約是1:2.2,差異有統(tǒng)計(jì)學(xué)意義(t=-15.803,P值0.05);并且全體HSC-Cup患者行Dix-Hallpike test檢查后均能表現(xiàn)出水平相為主的眼震。5例輕嵴帽患者在Roll test中都能夠誘發(fā)出水平相為主、方向與轉(zhuǎn)頭方向同向的眼震,眼震時間較長,均大于1分鐘,強(qiáng)側(cè)的水平眼震強(qiáng)度為(10.6~27.8)°/s,弱側(cè)的水平眼震強(qiáng)度為(7.4~15.6)°/s。結(jié)論(1)Dix-Hallpike test是診斷PSC-Can的有效試驗(yàn)方法。在Dix-Hallpike test懸頭位或端坐位其表現(xiàn)為垂直向上或向下的扭轉(zhuǎn)性眼震,其中右PSC-Can仰臥懸頭時眼球震顫呈逆時針方向旋轉(zhuǎn),左PSC-Can仰臥懸頭時眼球震顫呈順時針方向旋轉(zhuǎn),坐起后運(yùn)動方向相反。并且,Dix-Hallpike test對HSC-BPPV也具有定位診斷意義,表現(xiàn)為HSC-Can向兩側(cè)仰臥懸頭時可引出與扭頭方向同向的水平眼震,HSC-Cup在仰臥懸頭時可引出與扭頭方向反向的水平眼震。而Roll test僅適用于水平半規(guī)管受累的定位診斷,并不能誘發(fā)后半規(guī)管內(nèi)的耳石產(chǎn)生有效刺激。因此,臨床檢查中對于可疑BPPV的眩暈患者,位置試驗(yàn)檢查時建議從Dix-Hallpike Test開始,依照Dix-Hallpike Test水平眼震的有無判斷是否需要繼續(xù)實(shí)行Roll Test,以減少對患者的不適刺激。(2)HSC-LC在Roll test和Dix-Hallpike test中均能引出連續(xù)的與轉(zhuǎn)頭方向同向的眼震,眼震時間大于1分鐘,且以上患者在頭偏向較強(qiáng)眼震側(cè)與矢狀面呈20°~30°處存在使眼震消失的零平面。
[Abstract]:Objective benign paroxysmal positional vertigo (benign positional paroxysmal vertigo, BPPV), otolith disease, is a very common clinical vertigo, often involving the posterior semicircular canal and horizontal semicircular canals. It is a recurrent, transient vestibular disease caused by transient dizziness and nystagmus caused by the head position relative gravity direction transformation. At present, the diagnosis of BPPV is usually determined by the typical nystagmus derived from the position test examination. In this paper, the video nystagmo graph (VNG) technique is used to analyze the parameter characteristics of the nystagmus of different types of BPPV in the two diagnostic tests of Roll test and Dix-Hallpike test, and discuss the BP The optimal scheme of PV induced nystagmus mechanism and position test in its clinical diagnosis provides an objective reference for the diagnosis of the responsible semicircular canal. Methods 740 cases of positional vertigo were diagnosed in the outpatient of the otolaryngology head and neck surgery department of Tianjin First Central Hospital from October 2015 to January 2017, including 735 cases, 237 men and 4 women. In 98 cases, the ratio of male and female to 1:2.1. was 510 cases (Posterior Semicircular Canal Canalithasis, PSC-Can), and 183 cases of horizontal semicircular canal stone syndrome (Horizontal Semicircular Canalithasis, HSC-Can), 42 cases of the horizontal semicircular canals of ampullary crest stone (horizontal semicircular). 5 cases of Light Cupula, LC). The history of vertigo (including vertigo, seizure time, frequency, accompanying symptoms, previous history and seizure inducement, etc.), and the improvement of the ear science and vestibular function examination, the imaging examination, the exclusion of central lesions, the existence of various types of spontaneous nystagmus and other kinds of BPPV (including PS) C-Cup, forearm HSC-Can, anterior semicircular BPPV). Use VNG to describe the nystagmus stimulated by all subjects Roll test and Dix-Hallpike test in detail, compare the parameters of each head induced nystagmus. Data processing with the support of the SPSS 19 statistical software. Results PSC-Can patients can lead to the Dix-Hallpike test. The vertical upward nystagmus, with the opposite direction of eye shock after sitting, the intensity is weaker than the hanging head, and the vertical nystagmus intensity (29.5 + 12.7) /s and (13.1 + 7.2) /s, respectively, is statistically significant (t=18.615, P0.05), and the duration of the typical nystagmus leads to the suspension position and the end seat, respectively. (13.7 + 7.1) s and (13.5 + 6.9) s, there was no statistical difference (t=0.089, P0.05). But the patients with PSC-Can in Roll test failed to lead to the typical continuous nystagmus.HSC-Can in the Roll test examination, which presented a horizontal phase with the same direction as the twist. The intensity of the eye shock in the affected side and the healthy side was (41.5 + 15.8) degree /s and (20.2 + 7.7) degrees /s, nystagmus, respectively. The ratio of the mean intensity was about 2.1:1, and the duration of nystagmus was (22.1 + 6.1) s and (21.3 + 5.9) s respectively. The differences were statistically significant (T values were 10.637 and 3.724, P 0.05), and 169 cases of HSC-Can patients showed the horizontal phase after Dix-Hallpike test in the Roll test examination. The nystagmus led to the contralateral twist was stronger than that of the patients. The nystagmus intensity was (18 + 8.1) /s and (40.27 + 16.6) /s, respectively, and the intensity ratio was about 1:2.2, and the difference was statistically significant (t=-15.803, P 0.05), and all HSC-Cup patients were able to show the water after Dix-Hallpike test examination. .5 patients with nystagmus in Roll test were able to induce the horizontal phase in the same direction and the direction of the turning head in the same direction. The nystagmus time was longer than 1 minutes, the horizontal eye earthquake intensity of the strong side was (10.6~27.8) /s, the horizontal eye earthquake intensity of the weak side was (7.4~15.6) /s. conclusion (1) Dix-Hallpike test was the diagnostic PSC-Can. The effective test method. In the Dix-Hallpike test suspension head or the end sitting position, it shows a vertical upward or downward twist nystagmus, in which the right PSC-Can supine hanging head rotates in the reverse clockwise direction, while the left PSC-Can supine hanging head rotates clockwise in the direction of the hanging head, and the movement direction is opposite after sitting up. And, Dix-Hallpike test to HS C-BPPV also has the significance of positioning diagnosis, which shows that HSC-Can can lead to the same horizontal ocystagmus with the direction of torsion when the head is supine on both sides. HSC-Cup can lead to horizontal nystagmus opposite the direction of the twist in the supine hanging head. While Roll test is only suitable for the localization diagnosis of the horizontal semicircular canals, and can not induce the production of otolith in the posterior semicircular canals. Effective stimulation. Therefore, in the clinical examination for the vertigo in suspected BPPV, the position test is recommended from Dix-Hallpike Test, and whether Roll Test is required according to the judgment of Dix-Hallpike Test level nystagmus to reduce the discomfort to the patient. (2) HSC-LC in Roll test and Dix-Hallpike test The duration of nystagmus was more than 1 minutes, and the zero plane of nystagmus disappeared at the head bias and the sagittal face at 20 ~30 degrees.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R764

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